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Force Protection Covers All Aspects of Troop Health

By Douglas J. GillertAmerican Forces Press Service

WASHINGTON, June 23, 1998  Health care for family members and retirees isjust as important as field hospitals to deployed soldiers' ability toperform their mission, said a senior Joint Staff medical planner.

"We've got to stop thinking of [service members] as beingautomatons who just take orders, go off over the horizon and forget aboutthe world until such time as they may come back," said Dr. (Rear Adm.)Michael Cowan, deputy director of logistics for medical readiness.Deployed service members, he said, need to know their families are beingtaken care of and that they, too, will get the health care treatmentthey need before and after they retire.

"Whenever we put an American pair of boots in the field, we needto fill those boots with somebody who is healthy and fit to do thatparticular job," Cowan said. "That means a combination of the right kindof training, good health surveillance, vaccinations and good health habits.And that guy has to be socially and psychologically fit as well."

Cowan wields much influence as director of the Pentagon's forcehealth protection plan. Today, his concerns, and those of other medicaland line planners throughout DoD, are on the verge of changing medicaldoctrine. The changes, however, aren't revolutionary but rather reflectthe evolution of medical care, Cowan said.

The admiral said he and his medical colleagues changed their wayof thinking: U.S. medicine in the past focused on cure, while doctorstoday take more interest in prevention. For the military, he said, thistrend means deploying healthy, fit soldiers and protecting them fromenvironmental factors that could return them home ill or suffering fromnoncombat injuries.

Although military medicine in many ways follows the same pathsof progress as medicine in general, service medics face unique challenges,Cowan noted. As warfighting changes, so must military medics change theway they treat battlefield casualties, he said.

"The old business of deterrence and readiness has been replacedby shape, respond and prepare, which puts us into a full spectrum ofmilitary activities throughout the globe," he said. "The way we will goto war in the future will be on a sparse battlefield -- very few peoplecontrolling the battle with high technology and high lethality."

Cowan and his colleagues from DoD and the services settled onmore than a dozen priorities for improving force health protection. Theyinclude enhancing en route "care in the air" during medical evacuations,mobile surgical units, and environmental surveillance and protectionagainst chemical and biological hazards. Another priority, leveragingnew technologies, includes research and development of new products likelightweight packets of artificial blood and bandages that stop bleeding.

The services also must better document events affecting deployedservice members' health, a lesson learned from the Gulf War, Cowan said."One of the most acrimonious things about the Gulf War has been ourinability to reconstruct events -- where people were, what was done tothem and why. In the future when events occur that make us suspicious,we need to be on top rather that try to figure it out later on."

Even as the new rules are being written, the services aredeveloping and implementing the initiatives, Cowan said. "For example,we now know more about the soil, air and water of Bosnia than we knowabout Fort McNair [an Army installation in Washington, D.C.]. We're doingconstant surveillance, constant environmental probing, including lookingfor biological and chemical hazards including, but not limited to, warfare."

Another Gulf War lesson is the need to involve people in theirown health management, he said. "In the anthrax vaccination program,we're spending a great deal of time explaining to people why we're doingthis. Anthrax is a kind of poster child for force health protection.We have a terrible, dangerous risk of mass destruction and a safe vaccinethat can essentially eliminate that risk.

"All these things are coming together, and we are now experiencingrecord low levels of disease and nonbattle injuries in all of ourdeployments," Cowan said. "In Bosnia and Southwest Asia, those levels arebelow what you see in folks stationed back home."

Cowan's office plans to publish a capstone document this summerthat outlines force health protection measures for the next 10 years.The staff also has begun rewriting the joint medical doctrine. Bothdocuments will reflect the initiatives DoD is taking to better protectforces and take care of their families, Cowan said.

"The force health protection plan acknowledges that we've beendoing the right things -- but in bits and pieces and frequentlyreactively," Cowan said. "We can do better if we get in front."